The idle musings of a former military man, former computer geek, medically retired pastor and now full-time writer. Contents guaranteed to offend the politically correct and anal-retentive from time to time. My approach to life is that it should be taken with a large helping of laughter, and sufficient firepower to keep it tamed!

Monday, May 2, 2016

Welcome to 'death panels', UK style

It's emerged that tens of thousands of elderly and infirm hospital patients in Britain are effectively being condemned to death by their doctors - without them or their families ever being informed. The Telegraph reports:

As many as 40,000 patients a year are having “do not resuscitate orders” secretly imposed on them without their families ever being told, it can be disclosed.

A national audit of dying patients has highlighted a failure by authorities to tell relatives of plans put in place for their loved ones.

. . .
The same study showed that in 16 per cent of cases, there was no record of a conversation with the dying patient, or explanation for the lack of one, for the decision to put in place a do not resuscitate order.

. . .

Prof Sam Ahmedzai, chairman of the audit and author of recent guidelines on care of the dying, said: “When a decision has been taken [not to resuscitate], it is unforgivable not to have a conversation with the patient – if they are conscious and able – or with the family.

“If a doctor was dying they would expect this. We need to show the same respect to our patients.” he said. Prof Ahmedzai also said doctors also needed to be far more open with patients who were facing death.

“Not enough people are being told that there are biological indications they may be nearing the end of their lives,” he said.

This is the inevitable result of 'socialized medicine' or 'single-payer healthcare'. When the State pays for medical care, the bureaucrats administering the program don't care about the human beings involved. They care about forms, and budgets, and organizational power-building. Inevitably, doctors and nurses end up spending more time concentrating on meeting the requirements imposed on them by those who pay them than they do on caring for the patients they are sworn to help. The Hippocratic Oath becomes no more than a formality to be disregarded (or discarded) as a matter of expediency.

This means that cost inevitably triumphs over compassion. It's quicker and cheaper to let a patient die than to continue (often very expensive, time-consuming and resource-intensive) treatment. Therefore, let the weakest go to the wall. Reserve those things for younger and/or more healthy patients who have a better chance of being able to benefit from them. When money talks, the financial utility of life-saving measures becomes paramount. People with little life left to live are of less 'utility' to society than those who are younger, and who therefore have more time to be potentially productive members of society. Respect for the individual is replaced by respect for utility.

As we grow older, each and every one of us will be faced with this reality. Obamacare is one small shaved hair away from having precisely the same mentality. Already, if you're suffering from a terminal disease, you're likely to find your medical insurance reluctant to pay for expensive treatments, because they know you're unlikely to survive very long even if you receive them. They're looking at a cost-benefit analysis - and, from their perspective, it's hard to blame them. On the other hand, we pay for medical insurance on the expectation that it'll be there when we need it. Increasingly, that's no longer the case. (A recent example from my own experience is when I wanted to have extensive blood tests done prior to fasting, as part of a weight-loss and health-improvement program. My medical insurance was willing to pay out tens of thousands of dollars for bariatric surgery . . . but it adamantly refused to pay for [much, much cheaper] blood tests that would help me fast and diet to achieve precisely the same result as the surgery. Go figure.)

Sarah Palin was derided for warning of Obamacare's so-called 'death panels' - but in a very real sense, she was right. They're active in Britain now. It's worse in the Netherlands and Belgium. In so many words, it's legalized or legally tolerated murder - and it's coming here, too. Those of us who are older or in poor health need to start asking ourselves, "What am I and/or my family going to do about it?" If we don't know the dangers, we can't do anything to avoid or avert them. It's going to take far more intensive family intervention and monitoring of medical treatment (or the lack thereof) to avoid becoming part of the euthanasia statistics.

Oh come on now, this paranoid tinfoil, black helicopter stuff is getting old. This kind of thing could never happen here and you all know it. Why do you persist in this government bashing tantrum behaviour? You must just be troublemakers. Thats it, you are troublemakers trying to undermine our sincere work to improve mankind. What we need to do is deal with you so as to allow us to get back to our rightous efforts.

"“Not enough people are being told that there are biological indications they may be nearing the end of their lives,” he said."

Okay, everybody, reread that statement. The professor is stating TWO FACTS.

One, there are enzymes at the end of life that are elevated. How fast you expire depends on what kind of shape your heart is in. So if you are 75-85-90 in the hospital with several chronic health issues and they do a blood test that show that your enzymes are elevated. It is now time to switch from full-bore trying-to-get-you-health to hospice because all the fancy/expensive medical procedures are not going to change the outcome. In fact, in most cases those medical procedures actually are more harmful (life shortening) in older folks than doing less.

Two, what the good Professor is upset/concerned about is the LACK of informing the patient or family what is going on. Which, by the way, really pisses me off when I am dealing with end-of-life situation in one of my loved ones. I hate it when a doctor is blowing-sunshine when it is real apparent the loved one isn't going to make it.

Something like 80% of an average person's healthcare costs are incurred doing the final six months of life. Is it really any wonder that a state-funded program will try to shave off some of that expense?

Doctors, FYI, are the biggest fans of Do Not Resuscitate orders for themselves.http://time.com/131443/why-your-doctor-probably-has-a-do-not-resuscitate-order/

Also, this happens in practically every country, panels or not. Does it make sense to resuscitate a 85 year old terminal cancer patient?

No. My mother is a doctor and she is regularly pissed that her boss, who is insane in that peculiar narcissistic way and has killed probably dozens through stupid decisions over the year, keeps wasting resources on such patients.

The opposite happened with my mother. She had a DNR. It was not on file in the branch of the hospital she was in but was on file many other places of the same hospital. If they had not resuscitated her per her orders, she would not have suffered horribly and wasted away for several weeks.

Here in Alabama, it doesn't much matter if you do have a DNR or Advance Directive on file if you've got kids or a spouse, or even a crazy estranged cousin from California who shows up at the last minute to protest. The things Dr. Wife (MD, boarded in Family Medicine and Palliative Care, predominantly sees a geriatric panel at the local VA) has to deal with on a daily basis are truly horrifying, especially the trashy families that insist Daddy stays on that ventilator so that sweet VA disability check doesn't stop coming.

And on the advice of many physicians, I've got, at age 40, a DNR on file. The stats on "successful" resuscitations are really ugly, and the older you get the worse it is. I don't begrudge anyone the right to want it, but not for me.